01060100 (2) CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT N0.
10177 N PORTAL AV EXTERIOR SOLUTIONS 01060100
OWNER'S NAME: APPLICATION SUB DATE
A. RAMESH 1771 SMITH AVE 06/18/2001
PHONE: SANITARY N0. CONTROL NO.
(408) 358-1233
O z Z ARCHITECT/ENGINEER: BUILDING PERMIT INTO
"00
OO BLD ELECT PLUMB MECH
H Z J LJ __.J L=1
Hi LICENSED CONTRACTOR'S DECLARATION
�+ 1hereby affrmthat 1amlicensed under provisionsofChapter 9(commencing
Job Description
10 2 with Section?001)IofDivision3OftheBusinessandProfession,Code,andmylicense RE-ROOF 23 SQUARES WSM
a m y is in full force and ellen. }-
m a LicenWU
se Class L3 Lie e
w 3 a.H W¢ Cmum
cmr
ce u,O wRCHDECT'S DECLARATION GLUT/O�+
3 1 understand my plans shall W used as puM1lie records /w1G
,ax.i e O Licensed Professionale� OWNER-BUILDER DECLARATION
0 I hereby affirm tbit,1 am exempt from the Connotes'.,License law for the
C a fellmving mason.(Section 70313,Business and Professions Cade:Any city or county $12900
O which requires a o
prton svut
to con ,mor.improve Jemolleh,m repay any smac m
o
vont 1. nc ,al y re.thp�l f rh pctmin mfl g dsnmrmem _ .. _ .__
eL Ih'n14'. Ii lo" ttd promo as ifII Corl,aitor,(' (Clcptc4 y,{,1 1 1' - �- - ukdUal10I1
(co pe g, 'Ih SectioniOW) fDivi- 3of.h Business adP fete.Code( 31'`t2'I10 �".d/U i-�M1a 1, r i` n�
m than he Is excmt theiefrnm and the basis medic alleged exemption.Any violation -
of Section 7031.5 by any appticam fora permit subjecesthe applicum m a civil penalty
.Afoot mem,h.nfvehundredd.1aa(s50)) 305APNPJp� t^•,.r. Occupancy Type
❑1,ss owner of Incised,or my employees with wages as their sole compensation, _ 1
wilt do the work,and the tmcmrc is not intended or offeree for sale(Sec.-70,1-1.
Bu,imxs abe Pmfessieas code:The Contractor's IJceme Law ares not apply.e an 601 - ROOF TEA1kg0F 'Inspections 7 .
ow,rc
r of property Who builds or impros'es thcmon,and who does such work himself 6 02 — ROOF PLYWOOD NAIL
or through his own employees. building
than such imvmveis sol are not intended of _- ___- _ - -, _ ___completion,the
Ir.howwenmeWildingeTurden fpumvnsolawedidnotmic gildor 603 - ROOF BATTENS j ''vi.
ammve fen.the owned oilef.will have the burden of pmving that he did not Wild or
imnro�= pumaree 604 — ROOF IN—PROGRESS
- sO e — - - . contractors_. --- — — ..
O L m owner prones p(Secrty am cadincss a comrofessi n,Coce:)TheC m t
newt the Preset(Sec.9to a,Business and Profession,who
Cade)The Contractor t n. . . •• '''� u
License Law docs not apply m rm owner of a commercials)
who W lids se improves Merton. I
-.and who ',Luens for such pmje<ts with a commemq.,)licensed pursvam.o.the .-_ - __... .... _ - _._... .__.. ............. _ .._ --. .--. .. . .... __
_ 01 am cxr's pj under
Inw.
_ ❑lam exvmpn under Scc. .B&PCfw this reason _. . ..u„
_ Owen Dam
WORKER'S COMPENSATION DECLARATION
s...• " Ihetebyelfrm under psnaltyof,xrjuO,mm,of,6m followingdcchmtinns: FINALEO
0 1 have ural will mad,main t"a Cenifcaic of Consent to self-inmre for W Aer's
Campensation, as provided far by Seminar 37W of Re Labor Cede. far the . 00T 15 2001
pindmin ince of the work for which alis pert...its issued,
p✓ use and will maintain Worker's Compra
morlun Insunce;as me,tim l by Section
`J]IIU of the Labor Code.for the performance of the work for which.his pemut is
issued'My Workces Com nation'Insurances"Or ad Policy numberaa: BUILDING..A 2/C,rg / rq/S CO.-. .. ._ _ - .. _ _
Cauri' a?LCrlO.tr Policy NO:SQ4prfd238•�O/ 3 D1Y G
t CERTIFICATION OF EXEMPTION FROM WQRKERS-, `• - {s /
COMPENSATIONINSURANCEs
.. -. ]- t.roc: Ut. .L;.. 1
(This section need not W completed if the permit its for one hundred dollars t Ls
,
Ic nify'tiia[;n the per a e r.he rk for oiilchtti:pe '.is issued.( (�s„ 'I _ •f'[ .-t - `
shall not employ any person in any asomm,sa to to become subject to.he Workers
Compensation Laws of Califomia.Dao
NOTICE TO APPLICANT:If.after making this Cenificate of Exemption,you should f' '
hecome'subject to the Worker's Compenennon provisions of the Libor Cade,you most
Q O forthwith comply with such ptovisinns or this permit shall le deemed revoked.
- . - . _-. -.. _—_. — .-._.
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t,
r o
'''1” re '" �'CONSTRUCTION LENDING AGENCY
' 1 hereby$Rifat that then is a canamnioti kndihe agency for the perfonnince
'Q 'Lender's Names-
_, ... ..._.._... .. ... .. ._ _... ._ ... -.
z Lenders Address .- .: - 7 • -- ,ds _ .',I'••n
V•� I mmify that I have mad this application and smm that the above information is
ka•i[... 'cone s:1.,me m comply with aR city and county ordinances and state laws mlating
O•U ,,mildia,ccau,tramlxw,i dhereby ane im ro,orwnumi,ii,cf,hi, tyro ter upon
FC.I-.qz the aW i_ dpndfor Wrys
V) liabilities Pd} s t. a pehch
ity
Y.in.any
way swe ugncaid
city
C ty consequence f the grantingOf this fistful.
8 i s indemnify and keep harmless the C pen against
'APPLICAND'
UNDERSTANDS AND WILL COMPLY WITH ALL MON-POINT
6
SOURCE REGULATIONS. Issued by: ate /O
O
.Signam,,mAppl'mam/Conuotor t, Dam'• Re-roofs
HAZARDOUS MATERIALS DISCLOSURE
Will the tgrplicato or future building aecupen store or handle harardeo,material Type of Roofas defined by the Cupertino Municipal Code.Chapter 1).12.and.he Health and Safety
Codc:Sbtion 35532(a)' •, - - - 1, ;:
.''Oyes ,.. JLI Na'
• - 1 ..- „ .,_ ;_';' ` '., "`l:',` :- . -_All roofs shall be inspected prior to any-roofingmaterial-being-installed. ............
wum applicant futurebuildingoccupantll,cegavmentafe tee nen If a roof is installed'without first obtaining an inspecti6n', Fagree•toYethove
a hi rd s air conumnamints as defined by the Bay Area Air Quality Management.
Dstrct all new gw4erials forgto
on. pplicant.understands and will comply with
Dy' " t -all non pont source s'. „t. • t
I
1 h =read.he It N .nal.,me, motions der Chapter 6.95 f the _1 J t d In., -,fth WlId' does ma cum only have a¢ -n.th tan ,comJity to nail ry.he _ V
ecgpa aft .rtyuiremens whit m psi mvissoaance of a Cenifibam 91
!� � 'gnature of Applicant Date
ow f rat anamagent - I Da.e All roof coverings to be Class "B" or better
. .... ..' ..:." -. -- - ' .• _ OFFICE